Pulmonary Arteriovenous Malformation in a Woman With Severe Mitral Valve Stenosis

An 86-year-old woman presented with a 1-week history of worsening dyspnea, wheezing, orthopnea, and paroxysmal nocturnal dyspnea. She denied chest pain, cough, or fever. She did not smoke cigarettes. Her past medical history included bioprosthetic aortic and mitral valve replacement for severe mitral stenosis and aortic regurgitation, paroxysmal atrial fibrillation, and rheumatoid arthritis. Her medications included methotrexate, valsartan, hydrochlorothiazide, and warfarin.